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Lung cancer death rates increased among white women in US regions
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Compared with declines observed in California, death rates as a result of lung cancer were observed to increase among white women aged younger than 50 years in the South and Midwest regions of the US, according to study results published in the Journal of Clinical Oncology.
Prior studies have reported declines in age-specific lung cancer death rates among women in the US abruptly slowed in women younger than age 50 years. Ahmed Jemal, PhD, American Cancer Society vice president of surveillance research, and colleagues attempted to determine whether this decline was comparable between states with dissimilar antitobacco measures and sociodemographic factors that affect smoking prevalence.
Researchers examined state-specific lung and bronchus cancer death rates from 1973 through 2007 by age, sex, and race from the National Cancer Institute’s Surveillance, Epidemiology and End Results mortality database. Using this database, researchers were able to analyze data from 1,076,613 lung cancer deaths in 23 states to assess an evolving pattern of lung cancer death rates among white women.
Researchers noted that analysis was restricted to whites due to the fact that lung cancer rates vary by ethnicity and insufficient data was available for non-white ethnicities in many states.
According to study results, while the decrease in age-specific lung cancer death rates among white women continued in younger age groups in California, the decline was observed to slow or even reverse among women younger than age 50 years in the remaining 22 states, especially in several southern and midwestern states.
For example, in Alabama, death rates continued to increase for women aged 70 years or more, whereas rates for young and middle-aged women decreased for a short time, but have begun to increase in women younger than age 50. Compared with California in which the lung cancer death rate for women born after 1950 is less than a third of that among those born in 1933, Alabama death rates in women born after 1950 is more than double that of women born in 1933. Comparable increased death rates in women born after 1950s were observed in many southern states, including Louisiana, Kentucky, South Carolina and Tennessee.
“The dramatic rise in lung cancer death rates in young and middle-aged white women in several Southern states points to a lack of effective policies or interventions, like excise taxes and comprehensive smoking bans, that deter initiation of smoking among teenagers and promote smoking cessation among adults,” Jemal said in a press release. “Our findings underscore the need for additional interventions to promote smoking cessation in these high-risk populations, which could lead to more favorable future mortality trends for lung cancer and other smoking-related diseases.”
Additional factors that may have contributed to variations in lung cancer mortality trends between states include the predominance of other known risk factors for lung cancer such as occupational and environmental exposures. Researchers, however, noted that these contributions are likely to be modest or minimal, since cigarette smoking in the United States accounts for more than 70% of lung cancer deaths in women.
“Our findings of higher lung cancer mortality in white women born since circa 1950 compared with white women born before 1950 in several southern and midwestern states have implications for strengthening existing programs or implementing new comprehensive regional programs to control tobacco use and promote smoking cessation among these high-risk women,” the researchers said. “Women who quit smoking in their 40s and 50s can reduce their lifetime risk of dying from lung cancer by half compared with women who continue to smoke.”
Disclosure: The researchers reported no financial disclosures.
Perspective
Back to TopNathan Pennell, MD, PhD, MD, PhD
Tobacco smoking is unquestionably the most important risk factor for developing lung cancer, the deadliest malignancy in the United States and worldwide. The most effective way to decrease the numbers of deaths from lung cancer is to adopt policies that lower smoking rates in the population, and this correlation has been consistent over the past half century. Rates of smoking in men started to decrease in the 1960s and 1970s after the Surgeon General warned Americans that smoking was harmful, and this was reflected in falling death rates from lung cancer about 20 years later, a trend which continues today. At the same time, the rate of cigarette smoking in women rose in the 60s and 70s, which led to an increased rate of deaths from lung cancer in women that is only now beginning to reverse.
Dr. Jemal and colleagues carried out a very important study looking at death rates from lung cancer in cohorts of white women across various states in the US. Smoking policy, taxation, and regulation of tobacco products varies widely from state to state, from highly taxed and regulated states like California to loosely regulated states such as Alabama. The authors showed that states with strong anti-smoking policies have consistently had falling rates of death from lung cancer in women over the previous 2 decades, while southern and midwestern states with less aggressive anti-tobacco policies have shown much smaller declines or, as in Alabama, actual rising rates of lung cancer deaths in women born after 1950.
Although the authors correctly point out that the association of death rates by state with tobacco policy is speculative, the remarkable drop in lung cancer rates in California, with the strongest anti-smoking policies in the US, leaves little doubt of the association. Conversely, rising death rates from lung cancer in tobacco belt states should be a wakeup call for everyone, especially for regulators and legislators in those states that the time has come to strengthen anti-smoking programs and promote smoking cessation efforts.
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